Single Antiplatelet Therapy Following Left Atrial Appendage Closure in Patients With Contraindication to Anticoagulation

Left atrial appendage closure (LAAC) has emerged as an alternative to warfarin for stroke prevention in patients with nonvalvular atrial fibrillation (NVAF). Optimal antithrombotic therapy following LAAC is  an unresolved issue and current anticoagulation and antiplatelet strategies after LAAC remain empirical. In the PROTECT-AF (Watchman left atrial appendage system for embolic protection in patients with atrial fibrillation) trial, patients received short-term (45 days) anticoagulation followed by d ual antiplatelet therapy (DAPT) for a period of 6 months and then lifelong aspirin(1). In patients with a contraindication to oral anticoagulation, DAPT with lifelong aspirin and clopidogrel for 1 to 6 months has been recommended (2,3). The purpose of DAPT post-LAAC is to prevent device thrombus formation and cardioembolic events within the months following the procedure. However, most patients with a contraindication to anticoagulation have already experienced episodes of major or life-threatening bleeding and DAPT may be associated with a high risk of bleeding events in this population(4). Single  antiplatelet therapy post-LAAC may provide similar thromboembolic protection with a lower risk of bleeding episodes. However, there is a lack of data regarding the use of a single antiplatelet agent following LAAC. We aimed to evaluate the feasibility and preliminary safety and efficacy of single antiplatelet therapy after LAAC in patients with a contraindication to anticoagulation...

Source: Journal of the American College of Cardiology - October 18, 2016 Category: Cardiology Source Type: research